Provider Demographics
NPI:1275651168
Name:POTOMAC INTERNAL MEDICINE AND PEDIATRICS,LLC.
Entity Type:Organization
Organization Name:POTOMAC INTERNAL MEDICINE AND PEDIATRICS,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-934-9711
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-1734
Mailing Address - Country:US
Mailing Address - Phone:301-934-9711
Mailing Address - Fax:301-934-3998
Practice Address - Street 1:201 CENTENNIAL ST
Practice Address - Street 2:UNIT C-1
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5967
Practice Address - Country:US
Practice Address - Phone:301-934-9711
Practice Address - Fax:301-934-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052919207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185403800Medicaid
MDDC2304OtherRAILROAD MEDICARE
MDJ0240001OtherBCBS DC
MDKFL5POOtherBCBS OF MARYLAND
MD663MMedicare ID - Type UnspecifiedMEDICARE
MD185403800Medicaid